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General NPI Number Information
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NPI Number | 1295087211
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Entity Type | Organization
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Legal Business Name | CARLOS CORTEZ , A DENTAL CORPORATION
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/21/2012
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Provider Practice Location Address
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Address Line | 1330 S VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90006-4502
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Country | US
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Telephone | 213-383-7315
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Fax |
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Provider Business Mailing Address
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Address Line | 731 E VERDUGO AVE 101
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City | BURBANK
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State | CA
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Zip | 91501-3118
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS R CORTEZ
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Credential | DDS
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Telephone | 818-391-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 52845
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License Number State | CA
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